NURSING the FUTURE E-Learning and Clinical Care, in Kenya by Angela Nguku Printed by 4 Print Ltd
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POLICY VOICES SERIES POLICY NURSING THE FUTURE e-Learning and clinical care, in Kenya By Angela Nguku Printed by 4 Print Ltd. KT8 2RY 020 8941 0144 The Author The Policy Voices Series Angela Nguku joined the African Medical and Research The Policy Voices Series highlights instances of personal Foundation (AMREF) in 2005, while working in achievement with wider implications for policy makers Southern Sudan. She was appointed as the first in Africa. coordinator of the AMREF Virtual Nursing School In publishing these case stories, Africa Research Institute (AVNS) in 2007. seeks to identify the factors which lie behind successful Angela was born in 1979 in Nthongoni village, Makueni interventions and to draw policy lessons from individual district, in Kenya’s Eastern Province. She attended experience. Precious Blood, a provincial Catholic school where she This series seeks to encourage competing ideas, completed her secondary education at age 17. After discussion and debate. The views expressed in the Policy school, Angela enrolled at the University of Nairobi Voices Series are those of the author, and not those of Medical School to study for a Bachelor of Science in Africa Research Institute. Nursing, where she graduated with honours in 2003. After an internship at Kenyatta National Hospital, Angela moved to Southern Sudan where she joined Action Africa, Acknowledgements a German development charity, in a project to train local Africa Research Institute would like to acknowledge the health workers in reproductive health. For AMREF, cooperation and encouragement of Dr Peter Ngatia, Angela was involved in setting up the the first midwifery Caroline Mbindyo, Mary Mbugua, Martin Kinyua and school in Southern Sudan, under the auspices of the Phillip Ngare at AMREF in Nairobi. Elizabeth Oywer, National Health Training Institute. She was a member of Registrar of the Nursing Council of Kenya, and the curriculum development team which introduced an Philomena Maina, Chief Nurse at Kenyatta National 18-month classroom programme in midwifery. Graduates Hospital, readily shared their time and insights. In from the programme are working in health institutions London, the advice and contributions of Jennifer Stobart across Southern Sudan. at AMREF UK and Matthew Edwards at Accenture were invaluable. This manuscript was compiled from AVNS is a nursing school established by AMREF in 2007 transcripts of interviews with Angela Nguku, with editing to improve the clinical and management skills of nurses in and additional research by Jonathan Bhalla. Cover design Kenya. The aim of AVNS is to develop practical guidelines by Krishna Stott. Editing and publication was managed and to encourage best practice in e-learning programmes by Aoiffe O’Brien. The project was made possible by the administered by nursing schools across the country. generous assistance of Richard Smith. Angela is currently studying for a master’s degree in nursing leadership and management, via distance Published by Africa Research Institute, 2009 learning, at the University of Dundee, Scotland. ISBN No. 978-1-906329-06-8 Africa Research Institute is a non-partisan think tank based in London. Our mission is to draw attention to ideas which have worked in Africa, and to identify areas where new ideas are needed. For more information please visit our website: www.africaresearchinstitute.org 43 Old Queen Street, London SW1H 9JA, UK 1 e-Learning and clinical care, in Kenya CONTENTS Foreword 4 By Mark Ashurst Director, Africa Research Institute 1. Introduction 7 2. A system under strain 7 3. The skills shortage 8 4. A hierarchy of training 8 5. The challenge: 22,000 nurses, nine years 9 6. Distance learning 10 7. The burden of print 10 8. A bright idea 11 9. Accenture 12 10. e-Learning 12 11. Growing pains 13 12. Responses 14 13. Clinical congestion 14 14. The next hurdle 15 15. AMREF Virtual Nursing School 15 16. Partnerships 15 17. The mobile support network 17 18. The student to tutor ratio 17 19. Output and achievements 18 20. Funding and governance 20 21. The brain drain 21 22. Recommendations 22 3 Nursing The Future Foreword Angela Nguku, coordinator of AMREF’s Virtual Nursing School (AVNS), shares many of the characteristics of the Nothing more needs to be said about the promise of nurses who are her students: she is a busy, practical, information technology to transform developing societies. no-nonsense kind of teacher. For Angela, much of the talk The precedents are encouraging. Across Africa, cellular of ‘designer’ technologies for Africa is exaggerated. She phones have brought instant communication to previously has no time for the fantasies of science fiction. AVNS, isolated villages. Market traders and rural farmers can for created in 2007, is both a laboratory and an incubator for the first time gain up-to-the minute pricing from markets the ongoing experiment that is e-learning in Africa. Its and manufacturers in the industrialised world. Internet electronic content avoids the costs and administrative kiosks, linked via satellite to cyberspace, cater to the burden of textbooks, but follows the same syllabus as growing demand for access to email even from small traditional classroom teaching, set by the Nursing Council towns and desolate highways. of Kenya. The basic premise of e-learning for clinical The next step is to demonstrate that electronic practitioners, then, is more organic evolution than a communication can leapfrog old ways of learning. If that radical break with the past. notion is no longer fanciful, it is equally true that much In common with every African nation, Kenya is severely remains to be proved. How, when and where technology affected by a shortage of clinical skills to tackle the can be applied to best effect are questions which invite a epidemics of the 21st century. Most of the country’s dizzying array of ideas and possibilities. Hundreds of 22,000 ‘enrolled’ nurses – the standard minimum nursing distance learning schemes are already underway, with qualification in Kenya – received their training before similarly varied results. From the pilot projects of South they were called on to treat complications and diseases Africa’s Industrial and Scientific Research Council in arising from chronic conditions such as HIV/AIDS, Pretoria, to Senegalese president Abdoulaye Wade’s malnutrition and poor sanitation in urban slums. ambitions for a high-tech university on the Atlantic coast at Dakar, it remains an immense challenge to translate The dimensions of the problem are well understood ideas into concrete results. by the ministry of health and the Nursing Council of Kenya. In 2001, they adopted a policy intended to The Policy Voices Series examines the policy implications upgrade the clinical skills of the country’s enrolled nurses arising from the experience of innovators in Africa. This – then estimated at 26,000 – to the higher standard of a paper considers the work of an organisation, chronicling ‘registered’ nurse by 2010. The estimated number of what must be the ultimate test of any distance-learning enrolled nurses was subsequently revised to 22,000. A programme: to achieve new standards of clinical care related plan to phase out the basic qualification for from hard-pressed nurses on the front line in Kenya’s enrolled nurses has not been pursued. For AMREF, busy hospitals and clinics. Mindful of that challenge, the however, the objective is unchanged: an e-learning African Medical and Research Foundation (AMREF) has programme to deliver a high output of trained nurses in a devised an e-learning programme supported by local short period of time. Close links to physical infrastructure instructors in nursing schools and other clinical centres enable nurses to train while continuing in full-time work across Kenya. If a computer-based syllabus can be at hospitals, health centres and dispensaries. effective in training clinical staff, within stringent criteria regulated by the Nursing Council of Kenya, surely other The e-learning methodology is recognised by the professions will find much to emulate in their example. ministry of health and regulated by the Nursing Council of Kenya. Both institutions are represented on the 4 e-Learning and clinical care, in Kenya steering committee which oversees distance learning. A larger and so far intractable deterrent is the cost of AMREF secured financial and technical support from tuition. The two-year programme to qualify as a Accenture, the global management consulting, registered nurse costs each student about US$1500. technology services and outsourcing company, building Average salaries for an enrolled nurse are in the range of on AMREF’s record in medical education and US$100-US$250 per month, dependent on employer, Accenture’s commercial experience in e-learning and experience and location. Most nurses in Kenya work software design. The partnership unlocked about US$3m either within the public sector, private or faith-based in financial and technical support from Accenture and institutions. For nurses such as Anne Kamene, a single Accenture Foundations – a record commitment both in mother of two with no savings and an elder child already cash terms and in the scale of pro bono contributions at university, more professional training involves a from technical staff. Accenture created bespoke teaching massive investment. Nor is there any guarantee of better materials and technical infrastructure to support rates of pay for registered nurses. In common with other successive versions of the programme from its launch in African states, Kenya lacks both resources and September 2005. appropriate structures adequately to remunerate improved skills. Most graduates have waited, often several years, For student nurses, AMREF’s course can seem daunting. for a pay rise. Resistance to technology – sometimes verging on “technophobia,” according to Angela – proved a frequent As this paper goes to press, about 600 Kenyan nurses obstacle. Students are offered training in basic computer have qualified via e-learning, with a further 5,798 in skills – a mandatory requirement for all applicants.